Wednesday, December 14, 2016

Early Christmas for Ontario's Doctors?

Yuletide surprise from the Minister of Health! With only 11 sleeps left...what could it be?!?

Right around the time most of us were polishing off our first coffee of the morning, Ontario's Minister of Health, Dr. Eric Hoskins, shocked just about everybody by sending the Ontario Medical Association (OMA) a brand-spanking new contract offer. Not to be outdone, and almost certainly before most anyone was even aware an offer was on the table, Hoskins released the details to the press, something doctors were none too pleased with, justifiably so. But that's the optics and the politics, and rarely does that stuff matter in the end. What about the details of the offer itself? And how does it compare with the rejected offer that was the cause of so much controversy last summer? Would Christmas come early for the doctors?

The major details in the offer are as follows:

  • a 2.5% increase in the global budget for doctors
  • increases of 1.4% per year for family doctors in team-based practices providing after-hours care
  • restoration of the number of openings for family doctors wishing to join comprehensive team practices to 40 per month
  • discounts on doctors' billings in excess of $1 million
  • across-the-board cuts to fees for common radiology and ophthalmology services
  • no more unilateral cuts
  • an appointed consultant to conduct a review of the outdated fee schedule to better reflect technology and inter-specialty fairness - doctors call this hot potato "relativity"
(special thanks to the Globe and Mail's Kelly Grant for relaying the details on Twitter as they were released)

So? Is the deal a giveaway to the doctors? A giant lump of coal? Something in between?

It's something of a moot point, since the offer was rejected out of hand by the OMA. But a couple of things stand out:
  1. While cuts to the high-billing specialties were a near certainty under the previous deal, they're spelled out in stark, explicit numbers 
  2. The contentious global cap on doctor billings looks to remain in place, without and stated forgiveness of overage (as there was in the offer this past summer) 
  3. The dollar increases to family doctors is minute, given the repeat cuts and clawbacks that began in 2012 
  4. Restoring the family medicine spots is a good thing, but there's no indication the government is backing off on its bureaucrat-led micromanagement of family practices (which the Ministry seemed open to last summer)
  5. No mention of binding surprise there

It should come as no shock that the deal was felt to be about as enticing as a home colonoscopy (Canadian Tire will put that camera on crazy sale every so often), because by most measures it was worse than the tentative deal last summer. The ham-fisted attempt to seduce family doctors and new grads while alienating "big money" specialists might have worked six months ago, but the doctors are as fed up with Premier Kathleen Wynne and her governing Liberals as most Ontarians. With the global cap and Patients First provisions intact, and now an external consultant rather than the "co-management" outlined in the last offer, there was next-to-no incentive for the doctors to play ball, even the ones standing to gain the rather paltry 1.4% per year. That the OMA is all but openly endorsing Patrick Brown's Conservatives pretty much doomed any tentative agreement that didn't entail major concessions on the part of the government.

So no early Christmas for the doctors. Which is just as well, since it gives me more time to enjoy my early Christmas present, sent to me very own all-penis coloring and puzzle book!

I think I need to make some new friends.

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